Pappenheimer bodies are iron-rich (siderotic) inclusions within the cytoplasm of erythrocytes.

Features of Pappenheimer bodies:

(1) red to blue to purple on Wright Giemsa stain

(2) coccoid in shape

(3) often adjacent to the red cell membrane


The inclusions stain positive on Prussian blue or other stain for iron. They also stain with a Romanowsky stain due to the presence of ribosomes.


Conditions associated with Pappenheimer bodies:

(1) status post splenectomy

(2) sideroblastic anemia (myelodysplasia, lead poisoning)

(3) sickle cell anemia

(4) hemolytic anemia

(5) thalassemia


Differential diagnosis:

(1) Howell-Jolly bodies

(2) basophilic stippling

(3) platelet overlying a red blood cell


Pappenheimer bodies can cause a false elevation of the platelet count when an electro-optical counter is used.

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